Background. Diabetes mellitus is a metabolic disease which is seen increasing globally and is diagnosed and monitored on basis of invasive blood investigations. Salivary glands are affected in ...diabetes mellitus. The objective of this study was to assess ultrasonographic measurements of parotid glands and correlate with the glycosylated hemoglobin levels in type 2 diabetic mellitus and duration of type 2 diabetic mellitus and treatment regimens. Materials and Methods. This study was conducted on 50 subjects of type 2 diabetes mellitus and on 50 healthy controls. After HbA1C analysis of selected individuals, 100 individuals were grouped into group I (above 5.7) and group II (below 5.7). Ultrasonographic measurements (length (L), transverse dimension (TD), depth lateral to the mandible (DLM), and depth dorsal to the mandible (DDM)) of bilateral parotid glands were calculated. Statistical analysis was done using the chi-square test of significance and Spearman correlation coefficients. Results. On correlation with measurement of right (L, DLM, DDM) and left (TD, DLM, DDM) of parotid glands with duration of type 2 diabetes mellitus, we found a moderate positive relationship, whereas as for right (TD) and left (L), we found a low-positive relationship. Similarly, for right (L, TD, DLM, DDM) and left (TD, DDM) parotid glands with HbA1C, we found a low-positive relationship, whereas for left parotid gland (L, DLM) with HbA1C, we found a moderate positive relationship. The mean DLM of right and left parotids in the insulin group was found to be slightly more than that in the combined group which was statistically insignificant. Conclusion. Ultrasonographic measurements of parotid glands were found to be higher in study subjects as compared to control subjects, and they increased with increased HbA1C levels; also, there was no difference in treatment regimen. Ultrasonography could be a prospective diagnostic test for detection and monitoring of diabetes mellitus, and still further studies are required for this.
Persistent primitive hypoglossal artery (PPHA) is a rare embryonic carotid vertebrobasilar artery anastomosis. Hypoglossal artery arises from the internal carotid artery (ICA) between the C1 and C2 ...vertebral levels and traverses through the hypoglossal canal to join the vertebro-basilar system. We present a rare case of an anomalous right sided PPHA as a sole supply to posterior circulation of brain with absent/hypoplastic bilateral vertebral arteries in a two year child who had presented with acute left sided haemiplegia. Three dimensional time of flight magnetic resonance angiography identified an anomalous vessel arising from the right internal carotid artery at the level of axis vertebra and joining the vertebra-basilar arterial system after coursing through the right hypoglossal canal. This anomaly when present may predispose the person to aneurysm formation, ischaemia in the posterior circulation and atherosclerotic disease of the intracranial vessels.
Introduction: Precise imaging differentiation of intracranial tuberculoma and Neurocysticercosis (NCC) is essential for their effective treatment. Conventional Magnetic Resonance Imaging (MRI) is an ...effective modality in its evaluation. However, certain stages of both the diseases show significant simulation in their imaging features paving need for additional sequences like Magnetisation Transfer Contrast (MTC) for their precise differentiation. Aim: To determine the Magnetisation Transfer Ratio (MTR) and its role in differentiating between intracranial tuberculoma and NCC. Materials and Methods: A hospital based cross-sectional study was done from November 2017 to May 2019 in a tertiary care centre of Southern India, where 55 patients with imaging diagnosis of NCC or tuberculoma were subjected to Magnetisation Transfer (MT) imaging and the MTR ratio was analysed. Consistency and reliability of the measurements were confirmed by obtaining the values repeatedly. For each Region Of Interest (ROI), MTR was calculated using the formula: MTR = (Mo- Mt) x 100/ Mo Where, Mo- the mean signal intensity with saturation pulse off, Mt-the mean signal intensity with saturation pulse on. Mean MT ratios were obtained for each category with standard deviation (SD) from the Mean. The mean distribution of MTR was calculated by Kruskal-wallis test and the significance was ascertained by Mann-whitney test. Results: MT ratio of tuberculoma ascertained by the study was 25.42±0.81 (24.62-26.22). MT ratio of vesicular stage of NCC was 10.31±1.6 (8.71-11.91). MT ratio of colloid vesicular/ granular nodular stage of NCC was 23.38±1.22 (22.18-23.58). T2 invisible tuberculomas were better visualised in MT images. Post hoc tests showed mean difference in the MTR values of the lesions as significant with a p value of 0.03. Conclusion: MTC imaging and MT ratio aids in better detection of ambiguous lesions than the conventional MRI and is an effective noncontrast sequence for better detection of the disease load. Since its application is non-cumbersome, MTC can be effectively used as an addition sequence in the standard protocol. The mean MTR values obtained in the study were very well reproducible and were of statistical significance.
Introduction: Raised Intracranial Pressure (ICP) is one of the most important causes of morbidity and mortality in the setting of Intensive Care Unit (ICU). Identifying the raised ICP as early as ...possible correlates well with the positive outcome of patients, which as of now relies more on ocular fundoscopy/Computed Tomography (CT) of brain/invasive monitoring, which relies on professional expertise and/or radiation exposure which may not be available all the times at all the places. This study tries to rationalise the utilisation of the commonly available modality of ultrasound in the evaluation of raised ICP compared to CT of brain. Aim: To measure optic nerve sheath diameter in cases of suspected raised ICP and to assess suspected raised ICP using the reference standard of radiologic diagnosis by CT of brain. Also, to assess diagnostic accuracy of sonography of the ONSD compared to CT brain for predicting raised ICP. Materials and Methods: This is a hospital based prospective comparative study on 60 adults over a period from June to August 2016, divided into two groups A and B consisting of 30 each, Group A consisted of 30 healthy controls and Group B consisted of 30 test subjects with symptoms of possible elevated ICP. The test subject’s CT imaging result was considered to be positive if findings suggested radiologic diagnosis of raised ICP such as midline shift of >3 mm/effacement of ventricles/cisterns/significant cerebral oedema/sub arachnoid haemorrhage. Ocular ultrasound and CT-scan of brain was done in both group of patients. Results: Mean age was 31.9 years in the control group and 44.6 years in the test group. Median age was 30 years in the control group and 45 years in the test group. The upper limit of the normal ONSD in the control group was 4.9 mm and a mean of 4.7 mm, those patients in the test group had a mean ONSD of 5.5 mm and upper limit of 5.7 mm, which was significantly more than the control group. These results showed that patients with raised ICP have an ONSD in excess of the control data (p<0.05). The above results were confirmed with Levene’s test for equality of means (p< 0.005). Conclusion: Ocular ultrasonography for measuring ONSD can be used an early test for diagnosing raised ICP and can be repeated for re-evaluation. In addition, ONSD has the advantage of diagnosing raised ICP earlier than ocular fundoscopy. Utilising no radiation exposure and being portable, ultrasonography avoids dangers associated with transporting ill patients from ICU and enables repeated reassessment of ICP.
Introduction: The hip joint is a major weight-bearing joint in the human body. It is often difficult to assess painful hip disorders clinically. This necessitates the need for imaging to arrive at an ...accurate diagnosis. Magnetic Resonance Imaging (MRI) is an imaging modality with good soft tissue contrast and resolution for evaluating hip pathologies. Aim: To identify and study the spectrum of imaging features in various hip disorders in adults and to establish a differential diagnosis using MRI. Materials and Methods: A hospital based cross-sectional study was done from June 2017 to May 2018 in a tertiary care centre of Southern India, where 70 patients who presented with unilateral or bilateral hip pain were evaluated with MRI. Demographic data including the patients age and sex was collected. The clinical features with which the patients presented were recorded. Conventional radiographic imaging of bilateral hip bone in antero-posterior and lateral views were obtained. Specialized imaging using appropriate MRI sequences in various imaging planes were obtained. The collected data was analysed and the differential diagnoses described. Data analysis was done by descriptive statistics using Microsoft Excel and Epi Info. Results were presented as mean (maximum-minimum) and percentage. Results: Out of 70 patients, majority of them were in the 20-29 years age group, with a male preponderance overall and also in the study subgroups. Unilateral hip involvement was more common than bilateral. The most common clinical presentation was hip pain. The commonest hip disorder encountered was Avascular Necrosis (AVN) of the femoral head (n=50), followed by Osteoarthritis (OA) (n=10), Tubercular (TB) arthritis (n=4), Transient Osteoporosis of Hip (TOH) (n=2), Metastasis (n=2), Synovial osteochondromatosis (n=1) and Perthe’s disease (n=1). Each of the conditions showed specific age group in which it commonly occurred. Bone Marrow Oedema (BME), joint effusion, soft tissue signal intensity changes, synovial thickening and enhancement, articular surface changes and subchondral changes were the spectrum of imaging features which occurred in various hip disorders studied. Double line sign was pathognomic of AVN of femoral head. MRI was more sensitive than conventional radiography in the identification of presence of hip disorders like AVN in early stages and TOH. Conclusion: MRI enables assessment of articular structures, soft tissues and osseous structures of the hip joint that can be affected by disease. It helps in better staging of various hip disorders like AVN, OA, Perthe’s, etc. It can help diagnose early stages of AVN and TOH, where it can be missed on conventional radiograph and Computed Tomography (CT). Hence, its role in the evaluation of painful hip disorders in adults is invaluable
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